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Bischof A, Papinutto N, Keshavan A, Rajesh A, Kirkish G, Zhang X, Mallott JM, Asteggiano C, Sacco S, Gundel TJ, Zhao C, Stern WA, Caverzasi E, Zhou Y, Gomez R, Ragan NR, Santaniello A, Zhu AH, Juwono J, Bevan CJ, Bove RM, Crabtree E, Gelfand JM, Goodin DS, Graves JS, Green AJ, Oksenberg JR, Waubant E, Wilson MR, Zamvil SS, Cree BA, Hauser SL, Henry RG. Spinal cord atrophy predicts progressive disease in relapsing multiple sclerosis. Ann Neurol 2021; 91:268-281. [PMID: 34878197 PMCID: PMC8916838 DOI: 10.1002/ana.26281] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 11/06/2022]
Abstract
Objective A major challenge in multiple sclerosis (MS) research is the understanding of silent progression and Progressive MS. Using a novel method to accurately capture upper cervical cord area from legacy brain MRI scans we aimed to study the role of spinal cord and brain atrophy for silent progression and conversion to secondary progressive disease (SPMS). Methods From a single‐center observational study, all RRMS (n = 360) and SPMS (n = 47) patients and 80 matched controls were evaluated. RRMS patient subsets who converted to SPMS (n = 54) or silently progressed (n = 159), respectively, during the 12‐year observation period were compared to clinically matched RRMS patients remaining RRMS (n = 54) or stable (n = 147), respectively. From brain MRI, we assessed the value of brain and spinal cord measures to predict silent progression and SPMS conversion. Results Patients who developed SPMS showed faster cord atrophy rates (−2.19%/yr) at least 4 years before conversion compared to their RRMS matches (−0.88%/yr, p < 0.001). Spinal cord atrophy rates decelerated after conversion (−1.63%/yr, p = 0.010) towards those of SPMS patients from study entry (−1.04%). Each 1% faster spinal cord atrophy rate was associated with 69% (p < 0.0001) and 53% (p < 0.0001) shorter time to silent progression and SPMS conversion, respectively. Interpretation Silent progression and conversion to secondary progressive disease are predominantly related to cervical cord atrophy. This atrophy is often present from the earliest disease stages and predicts the speed of silent progression and conversion to Progressive MS. Diagnosis of SPMS is rather a late recognition of this neurodegenerative process than a distinct disease phase. ANN NEUROL 2022;91:268–281
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Affiliation(s)
- Antje Bischof
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Nico Papinutto
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Anisha Keshavan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Anand Rajesh
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Gina Kirkish
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Xinheng Zhang
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jacob M Mallott
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Carlo Asteggiano
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Simone Sacco
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Tristan J Gundel
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Chao Zhao
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - William A Stern
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Eduardo Caverzasi
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Yifan Zhou
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Refujia Gomez
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Nicholas R Ragan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Adam Santaniello
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Alyssa H Zhu
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jeremy Juwono
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Carolyn J Bevan
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Riley M Bove
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Elizabeth Crabtree
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jeffrey M Gelfand
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Douglas S Goodin
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jennifer S Graves
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Ari J Green
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Jorge R Oksenberg
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Emmanuelle Waubant
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Michael R Wilson
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Scott S Zamvil
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
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- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Bruce A Cree
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Stephen L Hauser
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
| | - Roland G Henry
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, 675, Nelson Rising Lane, 94158, San Francisco, California, USA
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Rocca MA, Valsasina P, Meani A, Gobbi C, Zecca C, Rovira À, Montalban X, Kearney H, Ciccarelli O, Matthews L, Palace J, Gallo A, Bisecco A, Gass A, Eisele P, Lukas C, Bellenberg B, Barkhof F, Vrenken H, Preziosa P, Comi G, Filippi M. Clinically relevant cranio-caudal patterns of cervical cord atrophy evolution in MS. Neurology 2019; 93:e1852-e1866. [PMID: 31611336 DOI: 10.1212/wnl.0000000000008466] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/04/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize the distribution and regional evolution of cervical cord atrophy in patients with multiple sclerosis (MS) in a multicenter dataset. METHODS MRI and clinical evaluations were acquired from 179 controls and 435 patients (35 clinically isolated syndromes [CIS], 259 relapsing-remitting multiple sclerosis [RRMS], 99 secondary progressive multiple sclerosis [SPMS], and 42 primary progressive multiple sclerosis [PPMS]). Sixty-nine controls and 178 patients underwent a 1-year MRI and clinical follow-up. Patients were classified as clinically stable/worsened according to their disability change. Longitudinal changes of cord atrophy were investigated with linear mixed-effect models. Sample size calculations were performed using age-, sex- and site-adjusted annualized percentage normalized cord cross-sectional area (CSAn) changes. RESULTS Baseline CSAn was lower in patients with MS vs controls (p < 0.001), but not different between controls and patients with CIS or between patients with early RRMS (disease duration ≤5 years) and patients with CIS. Patients with late RRMS (disease duration >5 years) showed significant cord atrophy vs patients with early RRMS (p = 0.02). Patients with progressive MS had decreased CSAn (p < 0.001) vs patients with RRMS. Atrophy was located between C1/C2 and C5 in patients with RRMS vs patients with CIS, and widespread along the cord in patients with progressive MS vs patients with RRMS, with an additional C5/C6 involvement in patients with SPMS vs patients with PPMS. At follow-up, CSAn decreased in all phenotypes (p < 0.001), except CIS. Cord atrophy rates were highest in patients with early RRMS and clinically worsened patients, who had a more widespread cord involvement than stable patients. The sample size per arm required to detect a 50% treatment effect was 118 for patients with early RRMS. CONCLUSIONS Cord atrophy increased in MS during 1 year, except for CIS. Faster atrophy contributed to explain clinical worsening.
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Affiliation(s)
- Maria A Rocca
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy.
| | - Paola Valsasina
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Alessandro Meani
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Claudio Gobbi
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Chiara Zecca
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Àlex Rovira
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Xavier Montalban
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Hugh Kearney
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Olga Ciccarelli
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Lucy Matthews
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Jacqueline Palace
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Antonio Gallo
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Alvino Bisecco
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Achim Gass
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Philipp Eisele
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Carsten Lukas
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Barbara Bellenberg
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Frederik Barkhof
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Hugo Vrenken
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Paolo Preziosa
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Giancarlo Comi
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
| | - Massimo Filippi
- From the Neuroimaging Research Unit (M.A.R., P.V., A.M., P.P., M.F.) and Neurology Unit (M.A.R., P.P., G.C., M.F.), Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology (C.G., C.Z.), Neurocenter of Southern Switzerland, Regional Hospital Lugano (EOC), Lugano; Faculty of Biomedical Sciences (C.G., C.Z.), Università della Svizzera Italiana, Lugano, Switzerland; Section of Neuroradiology and MRI Unit, Department of Radiology (A.R.), and Department of Neurology/Neuroimmunology (X.M.), Multiple Sclerosis Centre of Catalonia, Hospital Universitari Vall d'Hebron, Barcelona, Spain; NMR Research Unit (H.K., O.C.), Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, London; Nuffield Department of Clinical Neurosciences (L.M., J.P.), University of Oxford, UK; Department of Advanced Medical and Surgical Sciences, and 3T MRI Center, (A.G., A.B.), University of Campania "Luigi Vanvitelli," Naples, Italy; Department of Neurology (A.G., P.E.), Universitätsmedizin Mannheim, University of Heidelberg, Germany; Department of Radiology and Nuclear Medicine (C.L., B.B.) and Institute of Neuroradiology (C.L., B.B.), St. Josef Hospital, Ruhr-University Bochum, Germany; Department of Radiology and Nuclear Medicine (F.B., H.V.), MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, location VUmc, the Netherlands; Institutes of Neurology and Healthcare Engineering (F.B.), University College London, UK; and Vita-Salute San Raffaele University (P.P., G.C., M.F.), Milan, Italy
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